Provider Demographics
NPI:1871979328
Name:BLAKENEY, SHELLEY LANELLE (RDN, CSP, LD)
Entity type:Individual
Prefix:MRS
First Name:SHELLEY
Middle Name:LANELLE
Last Name:BLAKENEY
Suffix:
Gender:F
Credentials:RDN, CSP, LD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:120 THOMAS CT
Mailing Address - Street 2:
Mailing Address - City:TUSCOLA
Mailing Address - State:TX
Mailing Address - Zip Code:79562-1181
Mailing Address - Country:US
Mailing Address - Phone:214-763-8415
Mailing Address - Fax:
Practice Address - Street 1:120 THOMAS CT
Practice Address - Street 2:
Practice Address - City:TUSCOLA
Practice Address - State:TX
Practice Address - Zip Code:79562-1181
Practice Address - Country:US
Practice Address - Phone:214-763-8415
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2015-08-07
Last Update Date:2025-10-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TXDT81052133VN1004X, 133V00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes133V00000XDietary & Nutritional Service ProvidersDietitian, Registered
No133VN1004XDietary & Nutritional Service ProvidersDietitian, RegisteredNutrition, Pediatric